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Some races and ethnic groups are at high risk for osteoporosis. And in other groups, osteoporosis is relatively rare. Here's how genetic heritage affects your risk of getting the world's most common metabolic bone disease and what you can do about it.

Every year, more women suffer fractured bones caused by osteoporosis than the combined total of women who have heart disease and breast cancer. Men and women of certain ethnic groups are especially likely to develop osteoporosis, but there are also racial and ethnic differences in diagnosis and response to treatment.

Osteoporosis is vastly more common in some countries than in others

In the USA, 15.8 percent women and 6.0 percent of men will experience a debilitating bone fracture due to osteoporosis at some point in life. In Sweden, 28 percent of women and 15 percent of men develop symptomatic brittle bone disease but in China osteoporotic fractures occur in 2.4 percent of women and 1.9 percent of men. A woman in Norway is 15 times more likely to develop osteoporosis than a woman in Chile.

However, people all over the world lose height due to painless, asymptomatic fractures of the spine

Microfractures of the spine occur after the age of 65 in 70 percent of Caucasion women, 68 percent of Japanese women, 55 percent of Mexican women, and 50 percent African American women. Races and countries differ primarily in the severity of osteoporosis. An exception to this rule is Native American women, who have both very high rates of osteoporosis and tend to have osteoporosis of unusual severity.

Sex makes more of a difference for the risk of osteoporosis for white people than for people of other races

White women are about twice as likely to suffer a hip fracture as white men. However, sub-Saharan African men and women have hip fractures at about the same rate.

People of different races tend to get fractures in different places

White women in the United States are four times more likely than African-American women to experience fractures of the hip. Hispanic women in the United States have much lower rates of fractures than white women, except they are about as likely as white women to have fractures of the wrist. Why should this be? The longer the bone, the more likely it is to fracture. White women tend to have longer femurs than women of African descent.

In the United States, race seems to make a huge difference in recovery from fractures

This could be due to differences in treatment. 

Hip fractures can be a devastating event. About 50 percent of women and even higher percentage of men are unable to resume their former walking habits after a hip fracture. But the effects of a broken hip are still more devastating for African-Americans compared to other Americans. 

One study found that African-American women are six times more likely to be discharged from a hospitalization for a broken hip unable to walk than white American women. At least in the 1990s (it is possible treatment standards have improved), Black women in the US were 25 percent more likely to die after a hip fracture than white women, although white men were more likely to die after a hip fracture than Black men.

In the USA, white women are far more likely to be screened for osteoporosis than Black women

Medicare records show that 33 percent of white women receive DXA scans for osteoporosis, compared to just five percent of lack women.

What's the bottom line of the macro-level data on osteoporosis and race?

The message about osteoporosis and ethnicity seems to be that if you are from Scandinavia, or you are a white person in the United States, you have a relatively high chance of getting osteoporosis and a relatively good chance of getting effective treated for it. If you are African-American, you may need strong advocacy to get adequate treatment, and if you are a Native American, you are especially needful of assertive attention to your own care.

However, with the advent of at-home genetic testing, there are a few more personalized clues to the role of genetics in your personal risk of osteoporosis that you can pursue with direct-to-consumer genetic testing.

  • Estrogen receptor 1. Variations in this gene are predictive of the risk of osteoporosis after menopause.
  • Vitamin D. There are genetic tests for three of the pathways vitamin D is used to stimulate the production of bone.
  • WNT16. This gene regulates the incorporation of proteins that form the collagen "glue" that keeps the mineral content of bones together.

Who should consider getting these genetic tests for additional information about the risk of osteoporosis? 

  • If you have already been diagnosed with osteopenia or osteoporosis, these tests can give you and your doctor valuable information about the aspects of your treatment that are most important.
  • If you work indoors during the day or live in a cloudy climate, then information on vitamin D absorption is very helpful.
  • Anyone who has a condition that limits mobility could benefit from taking these tests.
  • Anyone who has a history of a minimal-trauma fracture could be helped by these tests.
  • Women of any race who have passed menopause may find this information useful.
  • Anyone diagnosed with low blood calcium or low blood phosphate also needs these tests.
If you are of European descent, you need these tests to help you manage your risk for osteoporosis. If you are not of European descent, your risk of osteoporosis is lower but the consequences of osteoporosis may be more severe. Get affordable genetic testing to work with your doctor to recover from osteoporosis more quickly and more completely.

  • Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007.22:465–475. doi: 10.1359/jbmr.061113.
  • Cauley JA. Defining ethnic and racial differences in osteoporosis and fragility fractures. Clin Orthop Relat Res. 2011 Jul.469(7):1891-9. doi: 10.1007/s11999-011-1863-5. Review. PMID: 21431462.
  • Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007 Aug. (158):1-235. Review. PMID: 18088161.
  • Photo courtesy of SteadyHealth

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